Get the free Medical/Dental Reimbursement Account Claim Form - okbu

This form is used by employees of Oklahoma Baptist University to claim reimbursement for medical and dental expenses under the Medical/Dental Reimbursement Account Plan.

How to fill out medicaldental reimbursement account claim

How to fill out Medical/Dental Reimbursement Account Claim Form

1. Obtain a Medical/Dental Reimbursement Account Claim Form from your employer or plan administrator.
2. Fill in your personal information including your name, employee ID, and contact details.
3. Indicate the type of expense being claimed (medical or dental).
4. List each eligible expense, providing the date of service, provider name, and amount charged.
5. Attach all necessary receipts and documentation for each service listed.
6. Sign and date the form to certify that the information is accurate.
7. Submit the completed form and documents to the specified address or through the online portal.

Who needs Medical/Dental Reimbursement Account Claim Form?

1. Employees who have incurred medical or dental expenses that are eligible for reimbursement under their employer's reimbursement account program.

For pdfFiller’s FAQs

What is Medical/Dental Reimbursement Account Claim Form?

The Medical/Dental Reimbursement Account Claim Form is a document that employees use to request reimbursement for eligible medical and dental expenses incurred by them or their dependents under a reimbursement account plan.

Who is required to file Medical/Dental Reimbursement Account Claim Form?

Employees who have incurred medical or dental expenses that are eligible for reimbursement under their employer's plan are required to file the Medical/Dental Reimbursement Account Claim Form.

How to fill out Medical/Dental Reimbursement Account Claim Form?

To fill out the form, provide personal information, details of the expenses being claimed, including date, type of service, provider, and amount, and attach any necessary receipts or documentation.

What is the purpose of Medical/Dental Reimbursement Account Claim Form?

The purpose of the form is to enable employees to claim reimbursements for eligible medical and dental expenses, ensuring they receive the financial benefits of their employer's reimbursement account plan.

What information must be reported on Medical/Dental Reimbursement Account Claim Form?

The form must report personal details of the claimant, dates of service, types of medical/dental expenses, service providers, amounts claimed, and any supporting documentation such as receipts or invoices.